08929 (SFD)Building .7SS'
Address A :969
Mailing - -_--�
Address 41615 Eclectic BF
City Zip Tel.
Contractor
Address
Tela
State Lic. I City
& Classif. $� 2AR423 Lic. #
Arch., Engr.,
Designer
Address I Tel
44
P.O. BOX 1504
78-105 CALLE ESTADO J%
LA GUINTA, CALIFORNIA 92253 /"
City ( Zip( State I
Lic. #
LICENSED`CONTRACTOR'S DECLARATION
I hereby affirm that I am licen ed under„provisions of Chapter 9 (commencing with Section
7000):of Division 3 of the Busi e S and Professions Code, and my license is in full force and
effec t w
SIGNATUREI-W :t' 7 DATE
t UWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to oonslrucl, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o1 the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec.. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves- thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for sale. If, however, the. building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Cor tractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C: for this reasop
Dat 1 E 4 owner t �s��
1 -
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have.(!x� certificate of consent to self -insure, or a certificate of
Worker's Compensation Insuran,6e, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the aboveinformation is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 09929
1bi1 U
11LDING: TYPE CONST.. OCC. GRP.
P. Number % 7l'f`- - to//
-gal Description 40 T f
Project Description SIM-0--99ML t7f 1fs..mll tC
Sq. Ft. No. No. Dw.
Size 140 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
js
Const.
g 510.
Mech.
Electrical
V24.q
Plumbing
129, 0
S.M.I. r
Grading_20
4
Driveway Enc.
Infrastructure
ga -14.93
Precise PISMS
n
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
NSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SO. FT. ®
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
WALL SQ. FT. ®
LUMBER GR.
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK 7
ROUND PLUMBING9� UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
7/937 w
SEWER O ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. a
FRAMING
FINAL INSP.
ROOFING ,',/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND s41
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
t
GARDEN WALL FINAL
A ER 1 TR CT
Received From: J �� n7 �� S CS
COACHELLA V LLEY WMT D SI
CASH RECEIPT DETAIL
/
Wo 30714
Date: y J
Address:
Account No. 6 �' '- ��J -3 • 0-1)
Lot(s) '
Tract sC
Service Address L �� f l/� O-�' Z
G.A. Code
1® Meter(s) -�
'• •.
$ a�v.J0
„
'---g /
tYSV L) V
Service(s) .
Cashier i
Order
❑ Backflow(s)
CVWD-439 (11 IN)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
—� Sanitation Capacity Charge'
SD
`� J L)
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL $ o� 6 7 • y
Remarks:
k ❑Copy to:
(
i
Cash
AJ
'• •.
Water Service
}�
Check
Money
Cashier i
Order
CVWD-439 (11 IN)
t
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